AMA draws line in the sand on Med­i­caid caps, drug price trans­parency

Modern Healthcare - - PHYSICIANS - By Maria Castel­lucci, Steven Ross John­son and Matthew We­in­stock

“As physi­cian lead­ers, we bear greater re­spon­si­bil­ity within our pro­fes­sion and so­ci­ety. We must con­tinue to put our pa­tients be­fore pol­i­tics.” Dr. David Barbe Pres­i­dent Amer­i­can Med­i­cal As­so­ci­a­tion

The Amer­i­can Med­i­cal As­so­ci­a­tion last week left no room for doubt about its stance on leg­isla­tive pro­pos­als to cap Med­i­caid fund­ing: It would be “dis­as­trous,” AMA board mem­ber Dr. Carl Sirio said dur­ing the group’s an­nual meet­ing last week in Chicago.

Dur­ing de­bate on a re­port about con­gres­sional ef­forts to re­peal and re­place the Af­ford­able Care Act, there was some am­bi­gu­ity over the as­so­ci­a­tion’s stance on caps. The AMA House of Del­e­gates ul­ti­mately de­cided to ap­prove lan­guage that ex­plic­itly op­poses Med­i­caid caps.

Health re­form was just one of sev­eral con­tro­ver­sial is­sues de­bated dur­ing the an­nual gath­er­ing of the na­tion’s largest doc­tors group. The House of Del­e­gates tack­led such top­ics as trans­parency in drug pric­ing and trans­gen­der bath­room bills dur­ing this year’s meet­ing.

Dur­ing his in­au­gu­ral ad­dress, new AMA Pres­i­dent Dr. David Barbe chal­lenged mem­bers to be ac­tive lead­ers both within their or­ga­ni­za­tions and na­tion­ally. The House of Del­e­gates ap­proved a mea­sure that en­cour­ages physi­cians to in­crease their in­volve­ment on boards of health-re­lated or­ga­ni­za­tions.

“We must op­pose ef­forts to weaken the health­care sys­tem or cause our pa­tients harm. And we must al­ways be open to al­ter­na­tive ap­proaches to achieve our goals,” he said. “As physi­cian lead­ers, we bear greater re­spon­si­bil­ity within our pro­fes­sion and so­ci­ety. We must con­tinue to put our pa­tients be­fore pol­i­tics.”

Here’s a short roundup of ac­tions taken by the House of Del­e­gates:

Opi­oids: The AMA de­layed vot­ing on a mea­sure that would have al­lowed physi­cians to pre­scribe the drug buprenor­phine for the treat­ment of opi­oid abuse with­out ob­tain­ing a waiver. Doc­tors must now com­plete eight hours of train­ing and other re­quire­ments be­fore re­ceiv­ing the waiver that al­lows them to pre­scribe the drug.

House of Del­e­gates mem­bers who sup­ported re­mov­ing the train­ing waiver re­quire­ment said it’s a bar­rier pre­vent­ing physi­cians from treat­ing pa­tients suf­fer­ing from opi­oid abuse. Those op­pos­ing the mea­sure were con­cerned buprenor­phine wouldn’t be ad­min­is­tered prop­erly with­out waivers, and that pa­tients would be able to go to an emer­gency room for a buprenor­phrine re­fill with­out re­ceiv­ing other on­go­ing ther­a­pies to treat their ad­dic­tion. The House of Del­e­gates will likely hold a vote on the mea­sure again dur­ing its in­terim meet­ing in the win­ter or at next year’s an­nual meet­ing.

More broadly, the AMA will cre­ate a task force to ad­dress a num- ber of is­sues, in­clud­ing a re­view of how physi­cians have re­sponded to the opi­oid cri­sis, mak­ing rec­om­men­da­tions for im­prov­ing pain man­age­ment education in med­i­cal schools and look­ing at strate­gies to bet­ter pre­vent acute pain.

Drug prices: The House of Del­e­gates ap­proved sev­eral items aimed at bring­ing more trans­parency to drug pric­ing.

Among other things, the group ap­proved poli­cies sup­port­ing laws that would:

Al­low the CMS to ne­go­ti­ate drug prices

Re­quire drug com­pa­nies to list the sug­gested re­tail price of med­i­ca­tions in any di­rect-to-con­sumer ad­ver­tis­ing

Re­quire drug­mak­ers make pub­lic any price in­creases of 10% or more in a given year

Ac­cel­er­ate re­view of generic drug ap­pli­ca­tions

“Phar­ma­ceu­ti­cal prices are com­pletely out of con­trol and that is a pub­lic health men­ace,” said a del­e­gate from New Eng­land. “This is a pub­lic health emer­gency—let’s make sure pharma gets a black eye.”

One mea­sure that was not widely sup­ported called for an “out of pocket” max­i­mum of $500 a month per pa­tient. Some mem­bers ar­gued that call­ing for such lim­its sim­ply shifts costs.

The AMA’s res­o­lu­tions on drug prices came as Pres­i­dent Don­ald Trump, some in Congress and pa­tient ad­vo­cacy groups cam­paign for poli­cies to rein in drug prices.

Soda wars: The doc­tors’ group amped up its ef­forts to curb con­sump­tion of sug­ary drinks. Mea­sures ap­proved by the House of Del­e­gates urge physi­cians to talk with pa­tients about the health risks of soda and other drinks, en­cour­age hos­pi­tals to serve healthy bev­er­ages, and push to re­move sug­ary drinks from schools.

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